The OTR/COTA Relationship

When your child receives occupational therapy, their therapist could either be an Occupational Therapist (OTR) or an Occupational Therapy Assistant (COTA).

First, I would direct you to review my post: “A Who’s Who of Occupational Therapy” so that you get a firm idea of the exact differences between these two therapists as far as credentials and job expectations.

Basically, when a COTA is treating a client, the OTR and COTA must work together to create an optimal treatment plan for a child. In the end, the OTR is in charge of supervising and signing off on the COTA’s work. This supervisory relationship can be great, indifferent, or just really, really bad.

Here are some of the issues that influence the OTR/COTA relationship in a negative way:

-A Duel of Education Versus Years of Experience
So technically, insurance reimburses the same amount of money for a COTA or OTR completing a therapy session. If that’s the case then why is the gap between therapists a whopping 4 years? (Associate degree vs. Masters degree) It makes the idea of getting a graduate degree and falling an extra $30,000 or more in debt seem a little less appealing now a days, especially in some settings when the gap in pay between the two might be negligible.

Regardless of why the gap in credentials so large, it can definitely create a rift between therapists. Say two 30 year old therapists work at the same clinic. One is a COTA with 10 years of experience, and one is a OTR with 6 years of experience. The only difference comes from the time it took both of them to finish school. When a parent calls and wants “whoever has the most experience.” I’ve seen an uncomfortable moment when the two might battle it out over which means more… education or actual years of practice.

As I’ve mentioned before, I think it takes a whole lot more than the letters after a name to make a therapist a good fit for a child. And for this reason I encourage parents to try to look past this as they find a therapist for their child. But on that same note, I know it’s hard not to feel a little defensive in this situation when you’re the therapist being judged.

-Straight Up Superiority Complexes
This can come in two forms. On one hand, some OTRs just want to exert their “power” and let a COTA know who is in charge. They might shoot down the COTA’s ideas and substitute them with their own. They might put the COTA on the spot and make them fight for their stance. They might just be plain ol’ mean and condescending. Sadly, I’ve seen all of these situations.

On the flip side, sometimes a COTA will want to put an OTR in their place due to the fact that they have been practicing for a much longer time. I mean, imagine being a COTA with 20 years of experience, only to have a new graduate OTR come in to your office and tell you what to do. Yeah, that can’t be fun.

-Unequal Caseload Expectations
Due to the extra paperwork responsibilities of an OTR, in some settings they have a lower caseload expectation. For example, a COTA might need to complete 35 hours of therapy a week and an OTR might have to complete 30. Even though the difference is justified by the additional responsibilities, this in and of itself can create a rift between the professionals, and a COTA might feel as if the expectations are unfair.

-Paperwork Battles
Since all of a COTA’s paperwork needs to be signed by an OTR, their “approval” of work can go down in many different ways. Sometimes it’s just looking over a document for grammatical errors and proper goal progression. Sometimes it’s an uncomfortable overhaul of an entire document. I know when I am reviewing a report of a COTA, I try to not put too much of my own preferences into their writing style. I might read a sentence and say, “that’s not how I would have said it,” but if the content is there, then I have learned to leave it alone. I’m not sure if every OTR feels this way.

-Disagreements over treatment progress
Sometimes there are just honest to goodness disagreements over the course of treatment. I might look at a set of goals that a COTA has for a client and ask, “why are you working on that?” With any therapist, I think it is important to be able to explain the reasoning behind your interventions versus just doing something that you’ve seen other people do. This has also been a learning process for me to accept that something isn’t automatically wrong just because it’s not the way I would do it.

-A Lack of Any Relationship
Sometimes an OTR might never really interact with the COTA that they are supervising. They sign off on paperwork, but don’t have the time or resources to appropriately supervise a COTA. Granted, there are many COTA’s out there that don’t necessarily require that direct supervision, but by law, there needs to be some sort of processes in place to assure that proper supervision is happening.

From my experiences, the ideal OTR/COTA relationship consists of adequate face time together, and a sense of trust and mutual respect for two different professional opinions. When therapists actually work together, the families benefit so much more, and it can create a much happier and productive work environment.

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6 thoughts on “The OTR/COTA Relationship”

It’s sad when you work with a COTA who does not follow POC because they feel like they know better….Scope of practice, roles, responsibilities, expectations and job description must be given emphasis in school and during fieldwork training to avoid issues with assuming roles as a professional. If OTRs&COTAs work together patient would benefit more.

Dear Anonymus OT,
I am an OT who recently started a contract position in a small speech office with pediatrics. The owner would like to hire a COTA so we can offer more OT services. Can you give me some idea of how to distribute the pay?

Hi,
Looking for some advice !
My son is on the Autism Spectrum…PDD-NOS.

In Pre-k he had OT and mastered tripod grip and was not in need of OT anymore.
In K – no one but me re-inforced it and he has a 4 finger grip where his ring finger does all the work.
My concern is as he gets older his had will get tired and he won’t finish his work. It’s happening now.

We’ve tried triangle pencils, a few pencil grips… Hand exercises. Squeezing a stress ball… Tapping each finger to thumb. I’ve seen the strength improve .. He started doing 5 stress ball squeezes and now is up to 20. I’m in early childhood… We do playdoh and all sorts of fine motor activities.

Not sure at this point if it’s habit -he is a creature of habit, or what 🙁

I was reading your pencil grip reviews and now don’t know what to do. I was going to try the claw. The other ones he just moves his fingers around the grip. Visual cues of pinch and flip are provided. After each word he seems to need to reposition his hand.

No one else seems to be concerned bc you can read his writing but that not the point… Right?

Right now we are trying a clothes pin on the pencil so the two smaller fingers have something to hold. We’ve tried a small squishy ball but that’s way to fun to mess with for him. Lol

What I find disappointing is that only one side is presented, the negative one. And it makes this seem as if this happens with all COTAs. While there may be issues, providing such imbalance only fosters problems, and doesn’t help solve them.

This is a great article on a difficult subject. I do think that it is important to mention that if OTs are required to sign the notes of an OTA, this is usually a requirement of the program or facility. National standards, and State Laws usually require that OTs engage in supervision with COTAs. If the OT is spend time signing the OTAs notes, this time does not count toward the time that is required for supervision. Most State laws require supervision, and they only count the time spent in direct collaboration and consultation between the two professionals. It is true that some employers do not provide adequate time for supervision, but it is the responsibility of both professionals to make employers aware of the requirements that they need to meet to keep their state license. The therapists need to know the definition of “supervision” in AOTA recommendations and in their State regulations. Continuing to practice when you know that you are not meeting the requirements of your license is an ethical issue for the therapists involved.

Welcome!

-The Anonymous OT’s mission is to provide a place for families and professionals to interact, speak freely, learn important, straightforward information, and share their experiences related to the world of pediatric occupational therapy.

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-Disclaimer: The information contained on this website is for informational purposes only. This website is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of a medical professional for any questions or concerns you may have.

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The information, including but not limited to text, graphics, images, and other material contained on this website are for informational purposes only. This website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a qualified health care provider for any questions you may have regarding you or your child’s health concerns, and never disregard professional medical advice or delay in seeking it because of something you have read on this website.